Although secondary alveolar grafting is a successful procedure for managing alveolar clefts, but graft success might be compromised in cases of wide alveolar clefts, insufficient soft tissue for tight closure on the graft, repeated failures of the grafting procedure and delayed alveolar grafting. Interdental distraction using bone-and tooth-borne distraction devices had their drawbacks and failed to give 3D control on the transport segment. Purpose: Approximating alveolar clefts by inter-dental distraction using Archwire-Borne distraction device with 3D control of the transport segment. Materials and Methods: 10 patients, 7 females and 3 males that had unilateral alveolar clefts were selected. The age range at the time of inter-dental distraction was 12-22 years with a mean of 16.9 ± 2.8 years. Vertical interdental and horizontal complete osteotomies was performed to incorporate the maxillary canine and the first premolar in the transport segment. Cone-beam CT was performed just before and immediately after Inter-dental distraction. A new reference system was designed for 3D analysis after automatic superimposition of the two CBCTs. Intra-operator reliability was performed to measure the error in digitization of all dental and skeletal points used in this study. Linear and angular measurements were performed on 3D-CBCT for the maxillary canine and first premolar teeth in the transport segment in the antero-posterior and mediolateral dimension. Also, the volume of the alveolar cleft pre- and post-distraction was measured in cubic mms and compared to each other by paired-t-test. Results: High Intra-operator reliability was found. The permanent maxillary canine was transported in a bodily movement forward, while the maxillary first premolar experienced slight tipping. The alveolar cleft volumes were significantly decreased post-distraction at P = 0.006. Conclusion: The Archwire–Borne Distractor used in this study was efficient in the approximation of wide unilateral alveolar clefts.
Learning Objectives:
After this session, attendees will be able to:
Recognize when it is challenging for the alveolar graft to be successful.
Demonstrate the difference between Fady's Distractor and other distractors.
Evaluate the effect of Fady's Distractor as it has been tested on 10 patients with unilateral cleft lip and palate.
